The Annual Wellness Visit Needs a Complete Makeover – Here’s How We Fix It

Last year, the Wall Street Journal published an exclusive healthcare expose titled, “The One-Hour Nurse Visits That Let Insurers Collect $15 Billion From Medicare.” Within it, the media outlet largely skewered the practice of annual wellness visits and questioned the intentions and integrity of payers. This is not the only public critique of these visits. Meanwhile, payers have always found it difficult to get members to answer their phones and open their doors. Completion rates for annual wellness visits consistently fall short of payer targets.

The foundational idea of providing an annual visit where a member’s health can be comprehensively assessed has lots of merit. For plans, it can be a way of confirming they are adequately compensated for the population they are managing. At the same time, they can improve their understanding of each member and ideally use such visits to boost engagement and improve the support members receive from the plan. Once the practice of annual wellness visits largely migrated to the home setting, the potential was pushed even higher.

At some point, annual wellness visits lost their way, inviting WSJ articles, policy discussions and lots of scrutiny. They have also managed to alienate many members. In 2023, The Centers for Medicare & Medicaid Services (CMS) launched risk adjustment model version 28 (V28) as a new strategy intended to improve payment accuracy and directly address some of the shortcomings of how annual wellness visits have been conducted. While V28 does reset some expectations related to the annual wellness visit, here are four things plans can do to make it work even better for them and their members.

1. Profit Can’t Be The Only Purpose

Simply going into the home to hunt for codes and boost revenue is not a recipe for success moving forward. Instead, organizations who prioritize patient care and actually create meaningful value while in the home will do two things. Number one, they will improve the health and wellbeing of vulnerable and medically complex individuals. And as a byproduct, they will naturally achieve appropriate revenue goals. Basically, if you do right by patients, you’ll do right by your business. This boils down to a health plan’s mission, vision and values. Plans approaching these wellness visits with pure intent, aligned with a higher purpose and acting in the best interest of the patient, will naturally find themselves in a better place.

2. Visits Must Be Engaging, Not Invasive

Historically, there has been far too little thought and consideration for what a member experiences during an annual wellness visit. Typically, a stranger enters the home, throws a battery of questions at the individual and then leaves. There is no meaningful follow up with the member afterward. The affiliated health plan gets what it needs. The member receives little value.  This is simply bad design. Organizations who take the time to imagine what the member wants, and what a positive experience might feel like, will see engagement rates go through the roof. You have to give members a reason to want you in their home. If you are fortunate enough for a member to open the door to their home, you have to do your best to create a joyful experience. This is important not only to maximize that initial visit but also to keep the door open in the future.

3. The “One and Done” Model Is Over

An annual wellness visit can be a key to opening the door to a member’s home for ongoing preventive care. If done well, it can establish a bond and an initial relationship with each member. From there, plans should fully leverage this visit to create a trusted, long-term relationship where they can continue to engage, educate, encourage and support members throughout the year.  Currently, the annual wellness visit is seen more as a one-time task. You get it done, and you leave. This leaves so much potential on the table. Changing the way we approach this would accomplish more goals for plans. This basically makes preventive care something that can be practically delivered, leading to healthier, less costly members. Sounds like the holy grail for a health plan to me.

4. Talent Must Be Used Way More Efficiently

For the most part, annual wellness visits have been conducted almost exclusively by nurse practitioners. There is a worsening shortage of these professionals across the country, and having these limited, and expensive, resources driving from home to home to complete wellness visits is not efficient, or appropriate any longer.

The advent of community health workers has provided an innovative and more cost effective approach for completing these assessments. CHWs can go to go door-to-door to establish initial rapport and engagement with individuals before pulling in an NP or a physician via telehealth to complete a clinical assessment. With this approach, you get the best of both worlds. A CHW is better at engaging the individual. This resource is also much less costly to deploy, making it easier to achieve a positive ROI. Meanwhile, precious NP and MD resources can be more efficiently leveraged and used at the top of their license across the healthcare system.

The Next Generation of the Annual Wellness Visit

The annual wellness visit can no longer be a clerical exercise. It needs to be clinical. It needs to have a purpose beyond revenue purposes. Just as importantly, the engagement process needs to be reimagined by putting the member at the center and asking questions like, “Will this create joy, and does this provide value to the member?” And lastly, how can these visits be used to spark a deeper and lasting connection with members?

If we take these steps, we can transform the annual wellness visit from a highly-scrutinized and ineffective tool into one of the most powerful engagement and chronic care management engines we’ve ever seen.

Are you ready to level up your plan’s approach to the annual wellness visit? Our team would love to share how we approach longitudinal, in-home care for members. Contact us today!